Surgeries for cervical intraepithelial neoplasia (CIN) have been linked to preterm birth, low birth weight, and pregnancy loss, among other adverse effects. But the mechanisms have not been entirely explained. Are the outcomes due to the surgery, the immunologic factors, or the risk factors associated with CIN?
The greater risk of pregnancy problems derives primarily from the treatment not from characteristics of human papillomavirus or CIN, say researchers from Kaiser Permanente Northwest, Duke University, and GlaxoSmithKline. They compared 322 women who had undergone excisional and ablative cervical surgery with 4,307 women who had not and with 847 women who had undergone only diagnostic procedures.
Of the treated women, 163 had a live birth within 1 year of treatment. Women who had undergone thick excisional cervical surgical procedures ( ≥ 1.0 cm) had approximately double the risk of preterm birth and low-birth-weight infants compared with that of the other 2 groups. The risk was higher if the baby was born within 1 year of surgery. The risk of cesarean delivery rose 20% with excisional surgery. The treated women did not have a substantially higher risk of dysfunctional labor.
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Among the women who had cervical surgery, 21% lost the pregnancy (25% of those with ablative and 19% of those with excisional surgery). By contrast, 18% of the unexposed women and 20% of the diagnostic-only group experienced pregnancy loss. The researchers say the positive association between pregnancy loss and ablative surgical treatment has not been previously reported. “These findings suggest that efforts to minimize excision thickness in cervical surgeries are prudent,” the researchers advise.
Source:
Weinmann S, Naleway A, Swamy G, et al. PLoS One. 2017;12(1):e0165276.
doi: 10.1371/journal.pone.0165276.
